Surgical Versus medical treatment of spontaneous supratentorial intracerebral hemorrhage

Abstract

Spontaneous ICH is a major life threatening condition.Spontaneous supratentorial intracerebral haemorrhage affects 20 in 100 000 people every year with a mortality of more than 40%. Most survivors are disabled. The management of such cases is difficult with many controversies. The major controversy is whether these cases benefit from surgical intervention or not and if so, what are the selection criteria? What is the best approach? In our study we analysed the effect of surgical versus medical treatment on outcome (mortality/morbidity)of 11 studies after a supratentorial spontaneous ICH which indicate a significant increase (p=0. 0.005) in the mortality rate in the conservatively managed group and a better functional outcome in the surgically managed group (p=0. 0.001). We conclude that surgical evacuation for spontaneous supratentorial ICH is to be the preferred choice of treatment for the cases GCS≥6 and for large hematomas (>30ml volume). Early surgery especially within 24 hours improves surgical results. Although craniotomy is the most preferred method, endoscopic technique seems to provide decreased morbidity and mortality rates. However the studies are not enough to analyze the best surgical type.